What To Do When You’re The First Advanced Practice Nurse At Your Workplace

With the Affordable Care Act and the shift in healthcare towards value-based payment, there has been an increased demand for nurse practitioners, clinical nurse specialists, and physicians assistants. This new model has made the “advanced practice nurse” the cool new kid on the block, and that’s fantastic because that means there’s a plethora of job postings! However, as many of us who have been around for awhile know, this also means that there are a lot of jobs out there being offered by people who don’t truly understand what APNs are and what they can bring to the table. This also gives us the exciting opportunity to build your own role and really show off what APN’s can do in a setting that maybe has never has interaction with one.

Being the cool new kid on the block is fun, but it isn’t always rosy. The main problems I see are either employers limiting us so we are not working at the top of our training, or asking us to do everything in an abusive way without giving us real backup (ie., saying you have a backup available by phone, but that person never picking up). There are horror stories aplenty, but I want to focus on what we can do to make sure you are not the next horror story.

Defining a role is exciting, and it can take shape in many ways. Either you are the first APN ever (which is becoming less rare but still happens), or you are the first APN they hired for a specific role that has never existed there before. Many times there are some precedents, but for the most part they are only described theoretically in research studies and white papers, or understood minimally by observing other practices that employ APN’s. This has resulted in the wide variety of responsibilities and day-to-day roles that we do, which is a big part why I love posting interviews about working APN’s. It’s good to know what everyone else is really doing, especially since it can vary greatly from what you observed in school and training.

So how can you successfully be the first advanced practice nurse at your job?

1. Try not to do this for your first job

This might be easier said than done, and I did it for my first job, and it’s not a career-killer by any means. However, from personal experience, it was extremely difficult. In your first year of practice, you want to focus on becoming an awesome nurse practitioner or clinical nurse specialist. That means that your primary goal and where most of your time is spent should be on working on your clinical skills, the day to day bread and butter of being an advanced practice nurse. When you are building your own role, you end up spending a lot of time problem solving things that might not necessarily be related to your clinical prowess, so you can end up in the fast lane towards burnout.

2. First focus on what they hired you for

One of the questions I highly recommend you asking any potential future employer is “Why do you want to hire a nurse practitioner/clinical nurse specialist?” What is their main objective, or what is the void they are trying to fill? If that is an agreeable proposition to you, then fantastic, continue pursuing the job. Once you start, focus on that objective or void they hired you for, and make sure you do it well. The nice thing about being one of the first advanced practice nurses’ they have worked with is that they might not realize that your interest or expertise can add beyond what they first hired you for. However, the best way to gain the trust you need to expand your role is to excel at what they hired you for initially – make that your objective and come up with 2-3 key measures that would prove you have met that objective. After you’ve met that objective, feel free to start coming up with ideas of your own! For example, a colleague of mine works at a high acuity resident clinic where patients are often referred to when they are discharged from the hospital without a PCP. In the beginning she acted as the constant for the patients in an environment with a never-ending revolving door of residents, then after several months she asked the clinic if she could open a chronic disease clinic one afternoon a week to focus on what she really loves to do. Now she is doing both, and is able to shape her role to her interests and the patients’ needs.

3. Start small

See gaps in care that are happening around you and start finding solutions for the ones that interest you the most. Use that nursing ingenuity and different perspective to your advantage, and start with a smaller project. Many times the first couple of months at a new workplace is getting to know the people you’ll be working with, and figuring out who will be your allies. Testing a small project is always a good way to do all of these things without appearing as if you’re trying to take over. If you start with too big of a project, some people may feel threatened by you. However small your project is though, do it with confidence and try to get buy-in along the way. I read some business books just to hone those change management skills that are a bit different from the nursing world, like How to Change the World by Jurgen Appelo. It’s an engaging change management book with lots of pictures, because let’s face it, I still don’t want to read one of those business textbooks my friends carried around.

4. Network with nurse practitioners whose jobs you want to emulate

I’m not much of a networker, but my experiences have forced me out of my comfort zone and into the crazy world of networking. I’m more of a one-on-one type of person, but you can learn so much from other advanced practice nurses that have been where you are. There are many different ways to network, but one of the easiest ways is to join your local branch of a professional organization such as AANP, your state’s version – so for California this is CANP, and other nurse-led organizations such as American Organization of Nurse Leaders. Ask questions about how they got to where they are, what challenges did they face, and how they overcame them. In many of these organizations there is also an official mentorship program that can help you in any stage of your career. This is also where you’ll meet the people who truly understand the struggle you face being the first one of your kind in a healthcare setting. We’ve been there before. We can help each other so it’s not so painful.

5. Get to know yourself

Get to know what your interests are, and what would make for the perfect job for you. You’ve started with a small project, gotten to know your team, gained the trust of your team, and asked other APN’s how they have gotten to where they are. By now you should have lots of ideas of where you can fit into a nice niche that makes both you and your employer happy. Even if you can’t do all the ideas you want, make sure you write them down in a notebook so that you don’t forget them. Change happens in the intersection between timing and opportunity, and just because something can’t be achieved now doesn’t mean it should be forgotten. So write those ideas down and revisit them every once in awhile. It’s really exciting to build your own role because you can have a significant impact on how healthcare is delivered in your setting. So always put your best foot forward, and always tell people you’re an advanced practice nurse. That’s the best way to pave the way for other people to take a look at you and think, “hmm..I think we would really benefit from having an APN join our team,” and someone else can get that great opportunity you had!

In the end, don’t be afraid to take that chance and be the first advanced practice nurse in a healthcare setting. I have seen it fail miserably when both parties are unsure of what they want, but as long as you know what you want and you like your workplace, things usually turn out well. I would love to hear any of your experiences building your role in the comments below!